Provider Demographics
NPI:1851867774
Name:PATRIA COUNSELING LLC
Entity Type:Organization
Organization Name:PATRIA COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MBR
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:803-594-3748
Mailing Address - Street 1:3025 BULL ST STE 303
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-2049
Mailing Address - Country:US
Mailing Address - Phone:912-484-4054
Mailing Address - Fax:
Practice Address - Street 1:3025 BULL ST STE 303
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2049
Practice Address - Country:US
Practice Address - Phone:912-484-4054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-18
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty